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Intense Exercise Post-MI?

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Intense Exercise Post-MI?

Post by mikenall on Mon Aug 18, 2014 8:20 pm

More hard evidence to support our views.

http://www.medscape.com/viewarticle/829988

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Re: Intense Exercise Post-MI?

Post by EugeneRunner on Tue Aug 19, 2014 11:13 pm

This is certainly discouraging news. I want to believe that significant running after my MI will reduce my risk, but I keep seeing articles like this that tell me the same thing. Low levels of exercise are good for you, but moderate to high levels of exercise are worse than doing no exercise at all. It seems like there must be more to the story than that.

Of course there is also the question of quality of life. It sure seems to me if you are doing something you love and is generally healthy, that should decrease the level of cardiac risk. Unfortunately the studies seem to not support that.

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Re: Intense Exercise Post-MI?

Post by Dave Tuttle on Wed Aug 20, 2014 4:27 pm

I thought it was pretty good news for me... The 25 to 30 mile per week maximum benefit range fits pretty well with my goals and comfort level and the risk for exceeding this amount seemed very small. Hopefully the recent increase in publicity recommending running for many/most heart patients will encourage and empower a lot more heart patients to lace up those running shoes.

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Re: Intense Exercise Post-MI?

Post by EugeneRunner on Thu Aug 21, 2014 1:31 pm

The way I'm reading this, the CV related mortality rate drops dramatically until reaching a certain level, and then skyrockets about that. The mortality rate is 3 times higher for those exceeding 7.2 MET-h/day vs. the category just below that at 5.4-7.2 MET-h/day.

That just doesn't make sense to me, that with more exercise there is a clear trend downward, and magically at 7.2 MET-h/day is shoots way up to worse than leading a sedentary life. It sure seems like there must be a lot more to the story.

Assuming this is right, no one should run a marathon after a MI, since you can't do that off sub 30 miles a week. My cardiologist has specifically banned me from racing marathons or longer, which I agree with not because of the risk from training, but the damage done by the race itself.

In my case, when I was running post MI (not now due to foot surgery) I was doing about double the amount of exercise recommended by this study as the maximum. If I manage to return to that level, I won't be just fudging the limits a little, but I would be way over the line.

When I returned to running, I discussed it at length with my cardiologist. We agreed there was a little risk associated with that, but it was minor compared to the improvement in quality of life. There was no way to quantify the risk, but I had in my head that maybe it was 10% - something I was willing to live with. If the actual number is 200% (tripling my risk), that is something extremely serious I need to consider.

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Re: Intense Exercise Post-MI?

Post by Dave Tuttle on Thu Aug 21, 2014 5:16 pm

I see your point EugeneRunner. There clearly needs to be more study on this. The numbers just don't make sense over 7.2 MET-h/day... It might help to reread some of the other articles in the "In The News" topic as I don't remember that significant of a threshold being mentioned in the other articles.

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Re: Intense Exercise Post-MI?

Post by EugeneRunner on Fri Aug 22, 2014 6:03 pm

This has been weighing on my pretty heavily, so I've looked into the study a little further and considered how the statistics apply to me personally.

First, the conclusion that a moderate volume of exercise is bad for your (over approximately 30 mpw of running, or the equivalent with other exercise) is poorly supported by this study. There were so few people in the study doing that level of exercise that a single cardiac event from that group could skew the numbers. Note that is says "p=.68" which means there is an enormous margin of error in that part of the study. Basically it means there is a 68% chance that the result was created by random chance, and not the amount of exercise. So the odds are very high the conclusion is simply wrong.

Even if there was some truth to the conclusion that moderate and higher volumes of exercise increase the risk, that doesn't mean this applies equally to each individual. This study lumps all MI's together. A 90 year old who had an MI stemming from congestive heart failure would clearly have a higher risk from intense exercise than someone with like myself who had a MI at 43 as the result of an isolated clot.

I'm fully convinced the only reason I'm alive to even ponder this question is the collaterals and general heart health that resulted from years of intense exercise.

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